Care of

Nursing in the
management
healing of
wounds and drainage
surgical
Mg. Dora Cieza Maldonado UN
«Pedro Ruiz Gallo»
 OBJECTIVES OF THE
PRESENTATION
■ Understand the importance of wound healing to prevent
surgical wound infection.
■ Strengthen knowledge about the risk factors that modify the
healing of the surgical wound.
■ Recognize the proper management of surgical drainage.
 HISTORY OF ACS INFECTIONS

■ Hand washing S emme l we i s

 HISTORY OF IACS

■ Florencia Nigthingale,
establishes the relationship
between mortality in
military hospitals with the
lack of hygiene and the use
of contaminated water

FLORENCE
NIGTHINGALE

1820- 1910
 HISTORY OF IACS
■ Lister in 1867
related
Pasteur's
studies to the
Louis Pasteur 1822-1895 bacterial
etiology of
suppurative
wounds.

Joseph Lister 1827-1912

CONCEPTUALIZATION

■ WOUND: Any traumatic injury to the skin

and mucous membranes, with continuity
and variable involvement of adjacent
structures.
■ SURGICAL WOUND:
Disruption of tissue integrity sec. To surgical
intervention
 PHYSIOLOGY OF THE
HEALING OF TH WOUND
E

Physiology of wound healing : from injury to maturation Paige Teller,

MD a, Therese K. White, MD, FACS b,Ã WORDS...
Ihop RISK FACTORS.

■ Agent
■ Guest
■ Hospital care .
 Ihop risk factors.
■ From the guest: Age
■ Control of sugar levels.
• Hospital
■ Suspend the use of environment
cigarettes.
■ Treatment of cavities. • Procedure Invasive

■ very short pre-operative • Error in processes

stay.
• Educate: staff,
■ neurological status students, users and
■ Emotional state families.
 WOUND INFECTION
OPERATION .

Sterilization ERROR IN I HOP

PROCESSE
S
Skin preparation

Creation of sterile fields

Qxca Wound
Management.
Environmental
cleanliness
 CLASSIFICATION OF H.QXCAS.

Clean wound : Operative wound not infected or inflamed,

which does not involve the respiratory, digestive, genito-
urinary (gu) tracts.

: Hda. Operation in the

which entry into the digestive, respiratory, gu tracts. no contamination
occurs.

■ Contaminated wound : Hda. Open surgery that is inflamed or hda.

Open trauma or proc. Qxco. with failure in sterile technique or from the
GIT.

■ Dirty wound : Hdaop. Clinically infected or perforated viscus or hda.

Devitalized trauma .
 Types of healing

■ c. for the 1st Intention: Aseptic, incised wound, which allows

immediate union of the edges of the wound.
■ c. for 2nd Intention: Wound with loss of
substance or is infected, cannot be sutured.
■ c. for the 3rd. Intention: Wound sutured after
a period of time, in which granulation tissue
grows.
 Nursing care
ASSESSMENT:
■ General condition of the patient
■ Personal and pathological history
■ Anatomical location of the wound and drainage
■ Evolution of the Wound: Appearance, exudate color,
humidity of the dressing, inflammation, size, stage.
 NURSING DIAGNOSES
Domain 11: Safety and Security
Class 2: Physical injury
d. of skin-tissue integrity R/c Incision Qxca. (00046)
Class 1: Infection
Dx. Risk of infection R/c Proc. Inv.,ambient Hospital, immune
system(00004)
Domain 12: Comfort Class 1: Physical comfort
Acute Pain R/c Increased sensitivity of nerve endings (00132)
Domain 9: Coping/stress tolerance
Class 2: Rptaal coping
Dx. Anxiety R/c health status
 Nursing interventions

■ SV monitoring
■ Fluid and electrolyte management
■ Adm. of medication: Analgesics and ATM.
■ Diet management.
■ Skin monitoring
■ Protection against infections
■ Interpretation of laboratory data
■ Hygiene and mobilization.
■ Assess drainage characteristics: catheter and secretions.
Procedure: healing
surgical wounds
 healing procedure
wounds
■ Objective : Facilitate the healing process and prevent
infection.
■ Rules:
■ Hand washing a/d procedure
■ Sterile procedure technique.
■ Inform the patient and guarantee their privacy.
■ Order will be 1st uninfected, then infected
■ Administer analgesic before healing.
 Wound healing material

■ Clean, sterile gloves

■ Sterile gauze: stamp gauze, dressings
■ Physiological serum + Antiseptic solution.
■ Sticking plaster
■ Dissecting forceps: each nail.
■ Straight Kelly scissors.
■ Ribbed probe, kidney bag, syringe
■ Waste bags, fcos. for sample.
 Healing procedure

PREPARATION OF THE PERSON AND THE

ENVIRONMENT:
■ Introduce yourself to the person and explain the
procedure.
■ Place screen
■ Administer analgesic 30 minutes before
■ Proper position
Keep going…….
■ Material preparation: Wash hands
■ Gather all the material, place the waste bag within reach and discover
what you need

■ Put on clean gloves and remove the dressing

■ If it is stuck, moisten with saline solution
■ Assess wound. Change gloves, but first open sterile equipment.
■ Put on sterile gloves, take the dissecting forceps and make a swab.
Soak with saline and antiseptic

■ Heal from the center outwards, if the wound is contaminated, heal

from the clean area to the contaminated area.

■ Rinse wound with sun. Salt as many times as necessary.

Keep going…..
■ Dry wound with G/E, apply indicated solution
■ Maintain drain isolated with dressing or
independent L/U gauze
■ Assistant must arrange patient's clothes and bed
■ Dispose of material in a closed bag and deposit it in the
container with a red bag. ( Tech.N°008)
■ Place instruments in enzymatic detergent
■ Hand washing, material replacement
■ Procedure record.
Management of wound drainage
operation
 DRAINS: Concept

All types of material

intended for evacuation or
derivation of a normal
secretion or
pathological from a cavity
or viscera to the

abroad.
 Drainage objectives

Eliminate fluid buildup

Prevent bruising
Reduce wound contamination
Minimize the scar
 GAUSE DRAIN
■ It consists of a gauze rolled in the shape of a
cigarette whose end is placed in
a wound or abscess and acts by
capillarity, facilitating fluid
from the

secretions .
 DRAINAGE WITH PENROSE
■ Rubber tube, placed before
completing the surgical intervention
and secured to the wall using a
suture. Secretions such as blood or
pus pass by capillarity, dragging the
liquids to the outside.
 DRAINAGE WITH PENROSE
■ Produces little tissue irritation.
■ It is indicated in subhepatic and
pancreatic abscesses, intestinal
anastomoses, peritoni and radical
surgery, in the existence and
prevention of muscular and
submuscular wall abscesses.
■ It is removed from the 4th or 5th day,
progressively, at the end the
attachment point to the skin is cut.
 KEHR DRAIN

■ T-shaped rubber or silicone tube, used for biliary

drainage, by leaving the horizontal branches of
the T inside the common bile duct and the
vertical branch externalized, through the
abdominal wall, so the bile flows through the
tube towards the duodenum, and a part goes
outwards.

■ Acts by gravity and connects to a closed, sterile

collection system to account for drainage

■ It is removed on the 9-10th day prior to

cholangiography.
 Bibliographic reference

■ Surveillance, prevention and IIH protocol: control

https://www.dge.gob.pe/portal/index.p hp?
option=com_content&view=article&id=547
&Itemid=383
■ Susana Rosales. Nursing fundamentals. 5th e. Mexico.
edit.: the modern SA manual
REFLECTION………….

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